Journal of endourology最新文献

{"title":"Pushing the Envelope: Ambulatory Percutaneous Nephrolithotomy for Patients with Complex Renal Calculi.","authors":"Christopher Connors, Kavita Gupta, So Yeon Pak, Alan J Yaghoubian, Blair Gallante, Dara Lundon, Roman Shiminov, William Atallah, Mantu Gupta","doi":"10.1089/end.2024.0649","DOIUrl":"10.1089/end.2024.0649","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Ambulatory percutaneous nephrolithotomy (PCNL) has grown in popularity for patients with smaller stone burdens and few comorbidities. Its feasibility in patients with complex renal calculi is less clear. In this study, we evaluate the safety of same-day discharge after PCNL for patients with complex renal stones when compared with those admitted after surgery. <b><i>Methods:</i></b> We retrospectively identified adult patients who underwent PCNL for complex stones from April 2019 to January 2021 at our institution. Our practice of routinely admitting patients was changed in October 2020 largely out of necessity amid the COVID-19 pandemic. Accordingly, all PCNL patients before this practice change were admitted, whereas those treated after were intended for same-day discharge. Patients were considered to have complex stones with either a Guy's Stone Score ≥3 or STONE nephrolithometry score ≥9. Baseline characteristics and rates of postoperative day 1 (POD#1) complications, 30-day complications, 30-day readmissions, and 30-day emergency department (ED) visits, as well as stone-free rates (SFRs) were compared between ambulatory and admitted patients. <b><i>Results:</i></b> Seventy-nine ambulatory and 111 admitted patients with complex renal calculi were included. Only one intended ambulatory patient required admission. The frequency of 30-day postoperative complications (ambulatory = 20.3%, admitted = 25.2%, <i>p</i> = 0.423) and POD#1 complications (ambulatory = 1.3%, admitted = 7.2%, <i>p</i> = 0.083) was lower among ambulatory patients, but these differences were not significant. Compared with admitted patients, the likelihood of an ED visit without readmission was significantly higher for ambulatory patients (8.9% <i>vs</i> 1.8%, <i>p</i> = 0.024), but the likelihood of readmission was lower (5.1% <i>vs</i> 9.9%, <i>p</i> = 0.222). Computed tomography-determined SFRs were similar (zero fragment rate 80.6% [ambulatory] <i>vs</i> 70.6% [admitted], <i>p</i> = 0.710). <b><i>Conclusions:</i></b> Same-day discharge and admitted patients demonstrate similar safety profiles and SFRs after PCNL of complex renal calculi without increased risk of readmission, suggesting that ambulatory PCNL is feasible for selected higher-risk patients.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"245-251"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Role of Laser Lithotripsy for Bladder Stones: Real-World Outcomes from Two European Endourology Centers with a Systematic Review of Literature.","authors":"Clara Cerrato, Maria Florencia Frascheri, Shriya Napoleon Fernandez, Esteban Emiliani, Paola Arena, Amelia Pietropaolo, Bhaskar K Somani","doi":"10.1089/end.2024.0640","DOIUrl":"10.1089/end.2024.0640","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> We aimed to look at the evidence for laser lithotripsy for bladder stones (BSs) to provide results from two centers on bladder calculi treatment. In addition, the outcomes of prostatic and other surgical interventions performed in nearly half of all patients. <b><i>Methods:</i></b> A retrospective analysis of two large European endourology tertiary centers for patients who underwent laser lithotripsy for BS between 2016 and 2024 (7 years). All patients provided consent and were counseled for the study accordingly, and the studies were registered as an audit in the individual centers. <b><i>Results:</i></b> A total of 122 patients were analyzed (mean age of 68.17 ±16.38 years; male:female ratio of 97:25). Thirteen (10.7%) patients had a preoperative long-term catheter. Overall, 42 (34.43%) patients had multiple stones (<i>n</i> = 2.19, ±2.08), with a median stone burden of 32.36 ± 24.13 mm. The mean operative time was 61.6 ± 37.25 minutes, with an overall stone-free rate (SFR) of 95.1% (<i>n</i> = 116). Postoperative complications were noted in nine (7.38%) patients, which included urinary tract infection or sepsis (<i>n</i> = 4, 3%), pain (<i>n</i> = 2, 1.6%), and bleeding/acute urinary retention/urethral stone (<i>n</i> = 1 each, 0.82%). All the complications were Clavien-Dindo I/II and treated conservatively. Six patients (4.9%) with planned concomitant surgical intervention needed a completion (second) intervention at a later date. Sixty patients (49.2%) had concomitant procedure along with their BS treatment. Twenty-two patients (18%) with a mean prostate size of 60.71 cc (±30.50 cc) underwent a transurethral resection of prostate (<i>n</i> = 16, 13.1%) or bladder neck incision (<i>n</i> = 6, 4.9%). Others underwent ureteroscopy (<i>n</i> = 13, 10.7%), transurethral resection of bladder tumor (<i>n</i> = 5, 4.1%), suprapubic catheter repositioning (<i>n</i> = 10, 8.2%), or urethral dilation (<i>n</i> = 10, 8.2%). The mean hospital stay was 1.4 ± 1.33 days. <b><i>Conclusion:</i></b> Laser fragmentation of BSs stands out as a safe and efficient choice with a good SFR and low risk of major complications, and perhaps should be considered the new gold standard for BS management. It also allows for concomitant treatment of enlarged prostate and other endourologic procedures with good outcomes.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"285-291"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wilson Molina, MD.","authors":"","doi":"10.1089/end.2025.52111.spot","DOIUrl":"10.1089/end.2025.52111.spot","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"213"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"The Safety and Feasibility of Ambulatory Minimally Invasive Partial Nephrectomy: A Systematic Review and Meta-Analysis\".","authors":"Shubham Kumar, Ahmad Neyazi, Rachana Mehta, Ranjana Sah","doi":"10.1089/end.2024.0923","DOIUrl":"10.1089/end.2024.0923","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"e324-e325"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment on A Trifecta-Based Evaluation of Patients Treated with Percutaneous Thermal Ablation of Small Renal Masses by G. Lucignani, et. al.","authors":"Ezequiel Becher","doi":"10.1089/end.2024.0767","DOIUrl":"10.1089/end.2024.0767","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"S46"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Obesity on the Outcomes of Supine Percutaneous Nephrolithotomy: A Propensity Score Analysis.","authors":"María Elena Martínez-Corral, Olalla Vázquez-Cancela, Cristina Fernández-Pérez, Daniel A Pérez-Fentes","doi":"10.1089/end.2024.0714","DOIUrl":"10.1089/end.2024.0714","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> The aim of this study was to evaluate whether obesity could influence the success and safety of percutaneous nephrolithotomy (PCNL) performed in the supine position. <b><i>Patients and Methods:</i></b> This prospective cohort study included 664 patients who underwent supine PCNL between September 2008 and June 2023. Patients were stratified into two groups: obese (272 patients) and nonobese (392 patients). To minimize bias, a 1:1 matching was performed between the groups based on Guy's stone score, preoperative stone burden, and potential confounding variables. Procedural success was defined as the complete absence of stones on CT performed 3 months postoperatively. Safety was assessed by the incidence of overall, infectious, and hemorrhagic complications, with complications graded using the modified Clavien-Dindo classification. <b><i>Results:</i></b> The obese patient group showed a significantly higher prevalence of hypertension, diabetes mellitus, and higher anesthetic risk according to the American Society of Anesthesiologists' classification. However, the complexity of the cases and the surgical technique employed were compared between the two groups. In the univariate analysis, no significant differences were observed in success rates (<i>p</i> = 0.118), overall complications (<i>p</i> = 0.222), hemorrhagic (<i>p</i> = 0.104), or infectious complications (<i>p</i> = 0.326). After matching, a significant reduction in hemorrhagic complications was identified in the obese patient group (odds ratio 0.43; 95% confidence interval: 0.18-0.97; <i>p</i> = 0.027). However, obesity was not associated with an increased likelihood of overall (<i>p</i> = 0.093) or infectious complications (<i>p</i> = 0.869), nor did it affect procedural success (<i>p</i> = 0.219). <b><i>Conclusions:</i></b> Obesity should not compromise the success or safety of PCNL when performed in the supine position. On the contrary, it may offer a protective effect against hemorrhagic complications. These findings suggest that supine PCNL is a safe and effective surgical option for obese patients, and obesity should not be regarded as a contraindication when the procedure is otherwise indicated.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"237-244"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI Fusion Cryoablation: Is There an Outcome Difference Between Anterior and Posterior Lesions?","authors":"Lara Rodriguez-Sanchez, Sonya A Lehmann, Michael W Kattan, Alberto Lopez-Prieto, Luis Avila-Moreno, Gloria Egui-Benatuil, Fernando J Bianco","doi":"10.1089/end.2024.0720","DOIUrl":"10.1089/end.2024.0720","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Cryotherapy pioneered ablation therapy for prostate cancer (PCa), initially using larger ablations. As the technique advanced, a more targeted approach was developed irrespective of lesion location. However, some clinical guidelines have addressed concerns for treating posterior areas. This study evaluates the validity of these concerns. <b><i>Materials and Methods:</i></b> We retrospectively studied 814 Magnetic Resonance Imaging Fusion Target Cryotherapy (MRFTC) treatment-naïve patients with PCa with a single index lesion (2013-2023) under local anesthesia. We grouped by treatment location: anterior, anterior-posterior, and posterior. Disease progression, defined as conversion to radical treatment, initiation of hormonal therapy, or development of metastases, was evaluated with survival analysis via the Kaplan-Meier log-rank test. Univariate and multivariable analyses were employed to compare outcomes among different treatment groups and other risk factors. Functional outcomes were evaluated using the Sexual Health Inventory for Men (SHIM) and International Prostate Symptom Score questionnaires, with comparisons made over time and by lesion location through <i>t</i>-tests. Complication rates were documented across the various treatment areas. <b><i>Results:</i></b> The distribution of patients' characteristics across treatment groups was similar. Procedure pain scores were similar irrespective of lesion location. Five years post-MRFTC, 87%, 89%, and 90% of patients treated for anterior, anterior-posterior, and posterior lesions, respectively, remained progression-free with no significant variation between groups (<i>p</i> = 0.22). For all groups, there were significant improvements in urinary function (baseline vs. 3 months). The posterior group showed a marginal, yet statistically significant negative difference in SHIM scores at 3 months. However, the score recovered by 1 year where no additional significant changes were noted. The most common complication was urinary retention and no cases of rectal fistula were reported. <b><i>Conclusions:</i></b> Our findings challenge clinical guidelines suggesting avoidance of focal cryoablation for posterior lesions. Using MRFTC, cryotherapy has proven to be safe and effective, regardless of lesion location.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"S21-S28"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thulium Laser Enucleation of the Prostate.","authors":"Christopher Netsch, Andreas J Gross, Benedikt Becker","doi":"10.1089/end.2024.0617","DOIUrl":"10.1089/end.2024.0617","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Anatomical endoscopic enucleation of the prostate (AEEP) is considered a size-independent method for treating lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) according to current international BPO guidelines. AEEP offers less perioperative morbidity compared with traditional transurethral resection of the prostate (TURP) or open prostatectomy while providing comparable long-term durability to open prostatectomy. The thulium fiber laser (TFL) is one prominent energy source for AEEP, which has been widely adopted around the world. We present a step-by-step surgical approach to thulium laser enucleation of the prostate (ThuLEP) using the TFL, describing a modified en-bloc technique for AEEP. <b><i>Materials and Methods:</i></b> In this video, a modified en-bloc technique is presented, performed by one surgeon (C.N.) at our institution. <b><i>Results:</i></b> In this example, the outcomes of the en-bloc technique are similar to those of traditional two- or three-lobe techniques. <b><i>Conclusions:</i></b> ThuLEP as a treatment for LUTS secondary to BPO results in excellent patient outcomes and can be offered as a treatment of choice for prostates of any size.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S1","pages":"S2-S7"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Port Robotic Transvesical Partial Prostatectomy: A Novel Approach for Focal Treatment in Prostate Cancer.","authors":"Adriana M Pedraza, Ethan L Ferguson, Roxana Ramos-Carpinteyro, Nicolas Soputro, Jaya S Chavali, Carter Mikesell, Jane K Nguyen, Jihad Kaouk","doi":"10.1089/end.2024.0347","DOIUrl":"10.1089/end.2024.0347","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> Given the favorable cancer-specific survival rates in localized prostate cancer and the negative impact of whole-gland treatments on functional outcomes, the field is moving toward precision strategies such as focal therapy and organ-sparing surgery. We aim to report medium-term functional and oncologic outcomes for the initial Single-Port Robotic Transvesical Partial Prostatectomy (SP-TVRAPP) patient cohort. <b><i>Materials and Methods:</i></b> We analyzed a prospectively maintained database of 20 patients who underwent SP-TVRAPP between February 2021 and March 2024. Inclusion criteria were prostate-specific antigen (PSA) ≤10 ng/mL, clinical stage ≤ cT2b, ISUP Grade Group ≤3, unilateral lesions on multiparametric magnetic resonance imaging (mpMRI) with positive biopsy cores on the same side, and preoperative IIEF-5 ≥ 17. We also considered bilateral prostate cancer in the anterior zone and invisible mpMRI tumors confirmed by unilateral positive biopsies. <b><i>Results:</i></b> At baseline, patients had an average age of 61 years, a median PSA of 4.8 ng/mL (interquartile range [IQR]: 3.7-7.7), and a median Sexual Health Inventory for Men (SHIM) score of 24 (IQR: 18-25). All procedures were completed without complications, need for additional ports, or conversion. After a median hospital stay of 4.2 hours, 94% of cases were discharged without opioid prescriptions, and Foley catheters were removed after approximately 4 days. At 6 weeks, 3, 6, and 12 months postprocedure, potency rates, defined as a SHIM score ≥17, were 45.0%, 77.7%, 83.3%, and 87.5%, respectively. When potency was defined as having erections sufficient for penetration, the rates were 80.0%, 88.8%, 88.8%, and 93.7% for the same time intervals. Regarding urinary function, 60.0% were continent at 1 week, increasing to 85.0% by 6 weeks, 88.8% at both 3 and 6 months, and reaching 93.7% at 12 months postsurgery. Oncologically, 30.0% experienced upgrading and 40.0% upstaging within this cohort. Negative surgical margins were attained in 85.0% of the cases and the median PSA was 0.4 ng/mL 12 months after SP-TVRAPP. Two men were found to have residual GG1 cancer in the protocol biopsies and are currently on active surveillance. At a mean follow-up of 15.5 months (0.2-34.8) months, none of the patients has required secondary interventions, and all remain free of both clinically significant residual prostate cancer and metastatic disease. <b><i>Conclusions:</i></b> SP-TVRAPP represents a promising treatment for certain patients with localized prostate cancer. This targeted surgical method has been associated with faster postoperative recovery and has demonstrated high rates of early recovery in erectile function and urinary continence while ensuring oncologic safety.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"261-270"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Robotic Assisted Laparoscopic Pyeloplasty.","authors":"Meghan F Davis, Arun K Srinivasan, Sameer Mittal, Aseem R Shukla","doi":"10.1089/end.2024.0399","DOIUrl":"10.1089/end.2024.0399","url":null,"abstract":"<p><p>Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis in the pediatric population. Management with an open dismembered pyeloplasty was first described by Anderson-Hynes in 1949; minimally invasive approaches have been increasingly utilized. In the subsequent text and accompanying video, we review the technique for dismembered robotic assisted laparoscopic pyeloplasty in the pediatric population. Large retrospective series demonstrate an over 90% success rate for robotic assisted laparoscopic pyeloplasty. Given success and complication rates are similar to an open approach, utilization of this approach will likely continue to increase.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S1","pages":"S60-S65"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}